Acitretin: What to know about this oral retinoid

Acitretin is a prescription oral retinoid most often used for severe psoriasis and other serious keratinization disorders. It can work when topical treatments and light therapy fail, but it’s powerful — and not a drug to take lightly. Here’s straight talk on how it works, what to expect, and the safety steps you must follow.

How acitretin works and who it’s for

Acitretin reduces excess skin cell production and helps normalize skin growth. Doctors usually pick it for pustular or erythrodermic psoriasis, or stubborn plaque psoriasis that hasn’t responded to other systemic options. Typically, treatment lasts several months and may be repeated based on response and side effects.

Typical starting doses range from 25–50 mg once daily with food. Your doctor will tailor the dose for your weight, response, and lab results. Don’t stop or change the dose without speaking to your prescriber.

Safety, monitoring and practical tips

Big safety points first: acitretin is highly teratogenic. If you can become pregnant, you must use effective contraception during treatment and for 3 years after stopping. Avoid alcohol while taking acitretin and for at least 2 months after—alcohol can convert acitretin into etretinate, a long-lasting compound that raises the pregnancy risk even more.

Before you start, expect baseline blood tests: liver enzymes, fasting lipids, and pregnancy test when appropriate. Your doctor will repeat tests during treatment (often monthly at first, then every 1–3 months). Watch for elevated liver enzymes or high triglycerides; doses may be reduced or treatment paused if labs change.

Common side effects are dry skin and lips, brittle nails, hair thinning, and sensitivity to sunlight. Use thick moisturizers, regular lip balm, and sunscreen. Avoid waxing or laser hair removal on treated skin—retinoids make the skin more fragile.

There are important drug interactions: avoid systemic tetracyclines (risk of raised intracranial pressure), high-dose vitamin A supplements (additive effects), and be cautious with methotrexate or other hepatotoxic drugs. Tell every provider and pharmacist you’re taking acitretin.

Don’t donate blood while on acitretin and for 3 years after stopping — many countries require this to prevent accidental exposure in pregnant transfusion recipients. If you plan pregnancy, discuss alternatives now; acitretin is not an option.

Call your doctor if you notice severe stomach pain, jaundice, extreme fatigue, unusual bleeding, sudden mood changes, or if you think you might be pregnant. For day-to-day care, simple steps—moisturize, protect from sun, check labs—make a big difference in staying on therapy safely.

If you have questions about dosing, monitoring schedule, or how acitretin compares to other treatments, bring them up at your next visit. It’s a useful drug for the right condition, but safety rules matter more than convenience.